The Compliance of Prescribed Activity Restriction in Women at High Risk for Preterm Birth

2020 ◽  
Author(s):  
Ghamar Bitar ◽  
Anthony Sciscione
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Medical Center ◽  
Compliance Rate ◽  
Tertiary Care ◽  
Prescribing Patterns ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Activity Restriction ◽  
The Impact

Objective Despite lack of evidence to support efficacy, activity restriction is one of the most commonly prescribed interventions used for the prevention of preterm birth. We have a departmental policy against the use of activity restriction but many practitioners still prescribe it in an effort to prevent preterm birth. We sought to evaluate the rate and compliance of women who are prescribed activity restriction during pregnancy to prevent preterm birth. Study Design This was a single-site retrospective questionnaire study at a tertiary care, academic affiliated medical center. Women with a history of preterm delivery or short cervix were included. Once patients were identified, each patient was contacted and administered a questionnaire. We assessed the rates of activity restriction prescription and compliance. Secondary outcomes included details regarding activity restriction and treatment in pregnancy. Continuous variables were compared with t-test and categorical variables with Chi-square test. The value p < 0.05 was considered significant. Results Among the 52 women who responded to the questionnaire, 18 reported being placed on activity restriction by a physician, with 1 self-prescribing activity restriction, giving a rate of our primary outcome of 19 of 52 (36.5%). All women reported compliance with prescribed activity restriction (100%). Gestational age at delivery was not different in women placed on activity restriction. Conclusion This questionnaire suggests that approximately one in three high-risk women were placed on activity restriction during their pregnancy despite a departmental policy against its use. The 100% compliance rate in patients placed on activity restriction is a strong reminder of the impact prescribing patterns of physicians can have on patients. Key Points

scholarly journals Impact of COVID-19 pandemic on maternity services and challenges faced by pregnant women delivering at a tertiary care centre in South India

2021 ◽  
Author(s):  
Parvathi Teja Naik ◽  
Rupesh Bala Murugan ◽  
Haritha Sagili ◽  
Subitha Lakshminarayanan ◽  
Priyadarshini Muruganandhan ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Tertiary Care ◽  
World Health ◽  
Categorical Variables ◽  
Contraceptive Device ◽  
Care Hospital ◽  
Continuous Variables ◽  
Maternity Services ◽  
The Impact

Background: Coronavirus disease 2019 (COVID-19), was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. India entered a nationwide lockdown on March 25, 2020, disrupting regular health services. Hence this study was conducted to estimate the impact of the COVID-19 pandemic on maternity services and to describe the challenges faced by pregnant women. Methods: A descriptive cross-sectional study conducted from July 2020 to October 2020 at tertiary care hospital, Puducherry, India. 422 pregnant women delivered during this period were included and detailed questionnaire was administered regarding antenatal, intrapartum, postnatal services and, challenges faced during the pandemic via telephonic call. Responses were documented in Epicollect version 5, transferred to Microsoft excel and analysed using Stata version 14.2. Continuous variables were expressed as mean (SD), and Categorical variables as proportions. Results: The 100% response rate was achieved with 32.5% high risk pregnancies. The 71.8% women availed direct emergency medical services while 28.2%. were referrals. The 79.9% and 25% of the women in third trimester had less antenatal visits and discontinued haematinics respectively. The 47.4% had first trimester testing, 30% didn’t receive lactation support. 81% and 69% of primiparous and multiparous women respectively had adopted postpartum Intrauterine contraceptive device as contraception. The 35-50% women faced challenges in availing essential obstetric care services.Conclusions: Development of robust linkage system between existing primary healthcare and tertiary care for managing both low and high-risk pregnancies is of paramount importance to alleviate maternal and perinatal mortality and morbidity.  

scholarly journals Changes in Pediatric Faculty Burnout During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Audrey M. Uong ◽  
Michael D. Cabana ◽  
Janet R. Serwint ◽  
Carol A. Bernstein ◽  
Elaine E. Schulte
Keyword(s):  
Emotional Exhaustion ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Academic Rank ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Exact Test ◽  
Faculty Burnout ◽  
Student’S T ◽  
The Impact

OBJECTIVES To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic and associated workflow changes, such as deployment on pediatric faculty burnout in an early epicenter of the pandemic. We hypothesized burnout would increase during the COVID-19 surge. METHODS We conducted serial cross-sectional surveys of pediatric faculty at an academic, tertiary-care children’s hospital that experienced a COVID-19 surge in the Northeastern United States. Surveys were administered pre-surge (February 2020), during the surge (April 2020), and postsurge (September 2020). The primary outcome was burnout prevalence. We also measured areas of worklife scores. We compared responses between all 3 survey periods. Continuous variables were analyzed by using Student’s t or Mann–Whitney tests, and categorical variables were analyzed by using χ2 or Fisher’s exact test, as appropriate. RESULTS Our response rate was 89 of 223 (40%) presurge, 100 of 267 (37%) during the surge, and 113 of 275 (41%) postsurge. There were no differences in demographics, including sex, race, and academic rank between survey periods. Frequency of burnout was similar in all 3 periods (20% to 26%). The mean scores of emotional exhaustion improved during the surge (2.25 to 1.9; P = .04). CONCLUSIONS Contrary to our hypothesis, we found no changes in pediatric faculty burnout after a COVID-19 surge. Emotional exhaustion improved during the COVID-19 surge. However, these findings represent short-term responses to the COVID-19 surge. Longer-term monitoring of the impact of the COVID-19 surge on pediatric faculty burnout may be necessary for health care organizations to mitigate burnout.

Abstract TP334: Clinical Impact of Hematoma Expansion in LVAD Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kara Melmed ◽  
David Roh ◽  
Josh Willey
Keyword(s):  
Hospital Mortality ◽  
Medical Center ◽  
Demographic Data ◽  
Similar Rate ◽  
Left Ventricular ◽  
Hematoma Expansion ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Ich Score ◽  
The Impact

Background: Intracerebral hemorrhage (ICH) in left ventricular assist device (LVAD) patients is a devastating complication. Hematoma expansion (HE) is associated with poor outcomes in ICH patients, but the impact of HE on LVAD patients is not known. Prevention of HE includes rapid and complete coagulopathy reversal, adding further potential complications in LVAD patients given the inherent risk of hardware thrombosis. We aimed to define the occurrence of HE in the LVAD population and to determine the association between HE and mortality in this population. Methods: We performed a retrospective cohort study of ICH patients with preceding LVAD implantation admitted to Columbia University Irving Medical Center between Jan 2008 and April 2019. Intentionally matched ICH controls without LVADs were identified to compare rate of HE in LVAD and non LVAD patients. ICH volume was measured using ABC/2 method.We defined HE as an increase in hematoma volume of 6 ml or 33% comparing the first and last scan in 24 hours. Demographic data was compared using Pearson’s χ2 test for categorical variables and students T test and Wilcoxon rank sum test for normal and non-parametric continuous variables. The association between HE and hospital mortality in LVAD patients was examined using regression modeling after adjusting for Glasgow coma scale, age, hematoma size and location and admission INR. Results: Of605 LVAD patients, we identified 40 patients with ICH. Of these, 28 patients met the inclusion criteria. Mean (SD) age of LVAD patients was 56 (10), 29% of patients were female and the majority (81%) of LVAD patients were supported by Heartmate II. The median (interquartile range [IQR]) baseline hematoma size was 20.1 ml (8.6-46.9), median (IQR) ICH score was 1 (1-2). HE occurred in 16 (57%) patients supported by LVAD, and in 50% of patients without LVAD with no difference (p=0.6).There was an association between HE and in-hospital mortality in LVAD patients after adjusting for admission ICH score and INR (OR of 20.5, 95% CI: 1.8-232.8). Conclusions: HE is a potentially modifiable risk factor for mortality. We demonstrate that LVAD patients experience HE at a similar rate to matched controls. We show that prevention of HE with anticoagulation reversal does not increase mortality.

Patients With Vasculitides Admitted to the Intensive Care Unit: Implications From a Single-Center Retrospective Study

2017 ◽  
Vol 34 (10) ◽  
pp. 828-834 ◽  
Author(s):  
Yael Haviv ◽  
Ora Shovman ◽  
Nicola Luigi Bragazzi ◽  
Kassem Sharif ◽  
Yarden Yavne ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Sofa Score ◽  
Medical Center ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cardiovascular Involvement ◽  
Life Threatening ◽  
The Impact

Background: Vasculitides are a group of disorders characterized by inflammation of vessels. Vasculitides may have life-threatening complications with significant morbidity and mortality; however, information regarding the outcome and prognosis of patients with vasculitides requiring intensive care unit (ICU) is scarce. Methods: Data of patients with vasculitides admitted to the ICU of the Sheba Medical Center between the years 2000 and 2014 were retrieved retrospectively. Continuous variables were computed as mean (standard deviation), whereas categorical variables were recorded as percentages. In order to investigate the impact of clinical variables on mortality, Student t test and χ2 analyses were performed. Results: Twenty-five patients with vasculitides were admitted to the ICU during the study period with mean age of 52 ± 14 years and sex ratio of male/female: 12/13. The mortality rate among these patients was 48%. Leading causes for ICU admission were infection (64%), disease exacerbation (34%), and hemorrhage (16%), while respiratory or cardiovascular involvement accounted for the majority of mortality during admission. An elevated Sequential Organ Failure Assessment (SOFA) score was significantly associated with mortality ( P = .041). Conclusion: Our study confirms the high mortality rate among patients with vasculitides who require ICU care as well as the roles of infection and disease flare-up as causes for admission. An elevated SOFA score was found to be predictive of mortality.

scholarly journals 127. walking to the Virtual Era. Analysis of the Telehealth Experience in the Infectious Diseases Clinic During the COVID Pandemic

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S193-S193
Author(s):  
Karen L Carvajal ◽  
Prishanya Pillai ◽  
Angelina Winbush ◽  
Rupinder mangat ◽  
Ted Louie
Keyword(s):  
New York ◽  
Infectious Diseases ◽  
Medical Center ◽  
Compliance Rate ◽  
Tertiary Care ◽  
Clinic Visit ◽  
P Value ◽  
Hiv Patients ◽  
The Impact

Abstract Background The COVID pandemic has changed and will continue changing the way we practice medicine. We sought to investigate the impact of telehealth (TH) in the delivery of healthcare in the general infectious diseases (GID), and HIV clinic during the COVID pandemic. The University of Rochester Medical Center is a major tertiary care and referral center for ID in upstate New York. From March through May of 2020, the clinics were closed, and nearly all visits were conducted by TH. Methods We surveyed (either by telephone or online) a total of 260 patients who participated in TH visits, with a mean age of 56 years in the HIV group and 59 years in the GID group. With a predominance of 62.8 of males v/s 37.2 of females. We collected information regarding the reason for the TH visits, access to technology, patient satisfaction, and preferences over in-person visits. We obtained the volume and no-show rate from prior years through EPIC. We evaluated compliance between in-person and TH visits using statistical analysis. Results We found 93.4% of GID and 84.3% of HIV patients surveyed, either strongly agreed or somewhat agreed that their TH visit was as satisfactory as a clinic visit. 67.5% of GID and 63% of HIV patients agreed that the option of TH would increase their compliance rate in the future. The no-show rate during the TH period in the HIV group decreased from 23% to 5% compared to the previous year, while the no-show rate in GID decreased from 9% to 4%. These results were statistically significant with a P-value &lt; 0.005 in both groups. Conclusion GID patients were more likely to have TH for hospital follow-up, follow-up of acute problems, and outpatient antibiotic therapy, compared to HIV patients, who more often had TH for chronic problems. GID patients were more likely to have the capability for televideo visits when compared to the HIV group, although this was not statistically significant. TH was statistically significant in improving patient compliance with appointments in both the HIV and ID clinics. Patients were overall highly satisfied with their TH experience and many patients also reported that continued availability of telemedicine would improve their compliance with appointments. Disclosures All Authors: No reported disclosures

The Impact of MassPAT on Opioid Prescribing Patterns for Otolaryngology Surgeries

2021 ◽  
Vol 164 (4) ◽  
pp. 781-787
Author(s):  
Samuel Rubin ◽  
Jacqueline A. Wulu ◽  
Heather A. Edwards ◽  
Robert W. Dolan ◽  
David M. Brams ◽  
...  
Keyword(s):  
Medical Center ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Prescribing Patterns ◽  
Care Hospital ◽  
Number Of Patients ◽  
Significant Difference ◽  
Awareness Tool ◽  
The Impact ◽  
Best Fit

Objective Determine whether opioid prescriber patterns have changed for tonsillectomy, parotidectomy, and thyroidectomy after implementation of the Massachusetts Prescription Awareness Tool (MassPAT). Study Design Retrospective cohort study. Setting Single-center tertiary care hospital. Methods Patients were included if they received tonsillectomy, parotidectomy, or thyroid surgery at Lahey Hospital and Medical Center (Burlington, Massachusetts) between October 1, 2015, and October 1, 2019. Prescribing patterns were compared prior to implementation of MassPAT, October 1, 2015, to October 14, 2016, to postimplementation of MassPAT, October 15, 2016, to October 1, 2019. Quantity of opioids prescribed was described using total morphine milligram equivalents (MME). Data were analyzed using univariate analysis, multivariate analysis, and trend line using line of best fit. Results A total of 737 subjects were included in the study. There was a downward trend in the quantity of opioids prescribed for all 3 surgeries during the study period. There was a significant difference in the quantity of opioids prescribed pre- and postimplementation of MassPAT for tonsillectomy (647.70 ± 218.50 MME vs 474.60 ± 185.90 MME, P < .001), parotidectomy (241.20 ± 57.66 MME vs 156.70 ± 72.99 MME, P < .001), and thyroidectomy (171.20 ± 93.77 MME vs 108.50 ± 63.84 MME, P < .001). There was also a decrease in the number of patients who did not receive opioids for thyroidectomy pre- and post-MassPAT (7.56% vs 24.14%). Conclusion We have demonstrated that there is an association with state drug monitoring programs and decrease in the amount of opioids prescribed for acute postoperative pain control for common otolaryngology surgeries.

scholarly journals Symptom Recognition to Diagnosis: Pathway to Care for Autism in a Tertiary Care Medical Centre

2020 ◽  
Vol 11 (01) ◽  
pp. 164-169 ◽  
Author(s):  
Suravi Patra ◽  
Binod Kumar Patro ◽  
Susanta Kumar Padhy
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Children With Autism ◽  
Autism Spectrum ◽  
World Health ◽  
Categorical Variables ◽  
Child Psychiatrist ◽  
Symptom Recognition ◽  
Pathway To Care ◽  
The Impact

Abstract Objective There is no systematic report on pathway to care in autism from tertiary care medical centers of India. The present study was aimed to evaluate the pathways to care among parents of children with autism-seeking treatment at a tertiary care medical center. Methods Cross-sectional, observational study involving parents of 38 children with autism spectrum disorder diagnosed with INCLEN diagnostic tool. Pathway to care was assessed using World Health Organization Encounter Form. Statistical Analysis  IBM Statistical Package for Social Sciences (SPSS) 20.0 was used for analysis; categorical variables were assessed using Chi-square test keeping statistical significance at 0.05%. Results A total of 74% parents reported going to a general practitioner and 13% reported going to a child psychiatrist as point of first contact. Among them, 71% parents reported seeking care with a child psychiatrist in a tertiary medical center at the fourth point of contact. Also, 84% parents believed in biomedical explanation of autism. Majority of parents sought for speech therapy and medicines for their child with autism which is in tune with their biomedical explanation. Parents were the first to identify developmental concerns, average age of symptom recognition being 2.2 years. Average age of intervention initiation was 40 months, 8 months prior to diagnosis of autism. Conclusions Early symptom recognition and initiation of interventions is encouraging. Despite having a biomedical explanation of autism and ability to recognize developmental concerns, there is a lag of 4 years in diagnosis and reaching a specialized child psychiatry setup. This lag is a cause of concern owing to the impact on access to evidence-based interventions.

scholarly journals COVID-19 restrictions and changing sexual behaviours in HIV-negative MSM at high risk of HIV infection in London, UK

2021 ◽  
pp. sextrans-2020-054768
Author(s):  
Iain Hyndman ◽  
Diarmuid Nugent ◽  
Gary George Whitlock ◽  
Alan McOwan ◽  
Nicolò Girometti
Keyword(s):  
High Risk ◽  
Hiv Infection ◽  
Sexual Activity ◽  
Sexual Behaviour ◽  
Well Being ◽  
Categorical Variables ◽  
Cross Sectional ◽  
The Impact ◽  
Mental Well Being ◽  
Hiv Negative

ObjectivesThe COVID-19 pandemic and its related restrictions have affected attendance to and delivery of UK sexual healthcare services (SHS). We surveyed the impact on sexual behaviour of men having sex with men (MSM) to inform future SHS provision.MethodsWe conducted a cross-sectional, anonymous, web-based survey among HIV-negative MSM at high risk of HIV infection who attended 56 Dean Street, a sexual health and HIV clinic. The survey was conducted over a 7-day period in August 2020. Data on sociodemographic characteristics, sexual behaviour and related mental well-being experienced during lockdown (defined as 23 March–30 June 2020) were extracted. Categorical and non-categorical variables were compared according to HIV pre-exposure prophylaxis (PrEP) use.Results814 MSM completed the questionnaire: 75% were PrEP users; 76% reported they have been sexually active, of which 76% reported sex outside their household. 75% reported fewer partners than prior to lockdown. Isolation/loneliness (48%) and anxiety/stress (27%) triggered sexual activity, and 73% had discussed COVID-19 transmission risks with their sexual partners. While 46% reported no change to emotions ordinarily experienced following sex, 20% reported guilt for breaching COVID-19 restrictions. 76% implemented one or more changes to their sexual behaviour, while 58% applied one or more steps to reduce COVID-19 transmission during sex. 36% accessed SHS and 30% reported difficulties in accessing testing/treatment. Of those who accessed SHS, 28% reported an STI diagnosis. PrEP users reported higher partner number, engagement in ‘chemsex’ and use of SHS than non-PrEP users.ConclusionsCOVID-19 restrictions had a considerable impact on sexual behaviour and mental well-being in our survey respondents. High rates of sexual activity and STI diagnoses were reported during lockdown. Changes to SHS provision for MSM must respond to high rates of psychological and STI-related morbidity and the challenges faced by this population in accessing services.

617 Who Benefits the Most from Burn Camps?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S162-S163
Author(s):  
Jennifer B Radics-Johnson ◽  
Daniel W Chacon ◽  
Li Zhang
Keyword(s):  
Retrospective Review ◽  
Burn Injury ◽  
Statistical Significance ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Self Evaluation ◽  
Significant Difference ◽  
Return Home ◽  
The Impact

Abstract Introduction Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child. Methods A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value&lt; 0.5. Results Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32). There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?” Conclusions In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.

scholarly journals Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s84-s84
Author(s):  
Lorinda Sheeler ◽  
Mary Kukla ◽  
Oluchi Abosi ◽  
Holly Meacham ◽  
Stephanie Holley ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
World Health ◽  
Communication Campaign ◽  
Electronic Screening ◽  
Novel Coronavirus ◽  
The Impact

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

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